FORM 1023-EZ for HEALTH ROOTS INSTITUTE

Field Data
EIN 81-5251256
Case Number EO-2018038-000262
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEALTH ROOTS INSTITUTE
Organization’s Mailing Address 2305 ASHLAND STREET STE C PMB 454
City ASHLAND
State OR
ZIP 97520
Accounting period End 12
Primary contact name MARION ROSE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARION ROSE
PRESIDENT
2305 ASHLAND ST STE C PMB 454
ASHLAND OR 97520

Officer/Director/Trustee Two

SANDRA MCDONALD
SECRETARY
47993 FLORAS LAKE LOOP
LANGLOIS OR 97450

Officer/Director/Trustee Three

LELAND SANCHEZ
TREASURER
941 MT PITT AVE
MEDFORD OR 97501

Organization’s website
Organization’s email WECARE@HEALTHROOTSINSTITUTE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/2/17
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K40 - Nutrition Programs
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MARION ROSE
Signature Title PRESIDENT
Signature Date 2/5/18

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